Deep Vein Thrombosis: What You Need to Know about DVT

Deep vein thrombosisIf you’ve spent much time flying you’ve probably heard suggestions to avoid developing deep vein thrombosis, “Get up! Walk around. Do some squats.” But what is deep vein thrombosis? If you never fly do you have nothing to worry about? And how do we test and treat DVT?

What is Deep Vein Thrombosis?

DVT occurs when a blood clot develops in a deep vein in the body, usually in the legs.

Think of a blood clot as a traffic jam: the torrent of vehicles trying to get out of the area make it nearly impossible for other cars to come in. The blood clot usually forms on the valves of a deep vein and creates an obstruction to the outflow of blood. This creates swelling, redness and pain.

“Deep venous thrombosis is a serious condition that needs immediate attention,” said Dr. Layla Lucas, a vascular surgeon and endovascular specialist at Saguaro Surgical.

According to the Centers for Disease Control and prevention, as many as 900,000 Americans are diagnosed with DVT annually.

Risk factors for DVT

Although blood clots have an increased prevalence with age, many assume clots only happen to older adults. However, the challenges can appear across the age spectrum from teens to seniors.

At some point in our lives, we have all been at risk of developing a DVT or subsequent pulmonary embolism. A pulmonary embolism most commonly results from a blood clot that migrates through the heart into the arteries of the lung.  It can be life-threatening if untreated.

The Cleveland Clinic Center for Continuing Education cites PE as the third most common cardiovascular illness after acute coronary syndrome and stroke.

It is important to recognize these risks in order to prevent this risk of DVT:

  • Frequent travel (long flights or car rides)
  • People who are immobilized
  • Major surgery or trauma
  • Past history of DVT
  • Pregnancy
  • Women taking oral birth-control
  • Obesity
  • Cancer
  • Autoimmune disorders such as lupus

What are the symptoms?

The symptoms of DVT can range from:

  • Minor pain and swelling to significantly swollen legs and arms
  • Changes in skin color (redness)
  • Leg pain
  • Leg swelling (edema)
  • Skin that feels warm to the touch

If the blood clot breaks off and moves through the bloodstream it can get stuck in the blood vessels of the lungs to form a pulmonary embolism.

Symptoms of a pulmonary embolism:

  • Chest pain
  • Coughing up blood
  • Light headedness
  • Sudden shortness of breath

How will your doctor test for DVT?

Your doctor will perform a physical exam and

  1. A blood test called a D-dimer is a fast way to test for evidence of a blood clot.
  2. Duplex ultrasound. TMC uses duplex ultrasound imaging to evaluate for DVT. Duplex ultrasound combines both traditional and Doppler ultrasound. The Doppler ultrasound creates a picture of the venous blood flow and can identify which vein the clot has developed in and how extensive it is.

What to expect when having a duplex ultrasound exam?

PE is best diagnosed with a CT scan of the chest. Certain high-risk patients may get another test called a V/Q scan.

How we treat DVT and PE

With a problem this prevalent, TMC has developed one of the busiest programs in the nation for minimally invasive DVT and PE interventions.

DVT is easier to treat the earlier it is caught. Patients are started on blood thinners right away. If the DVT is extensive and the symptoms are severe, they’re evaluated for intervention and clot removal.

DVT can typically be fixed during one or two treatments.

Dr. Lucas explained the treatment advancements are put to best use. “As vascular surgeons, we see the consequences of untreated DVT and PE and therefore are aggressive in our management of these conditions.”

To find out more about vascular exams and procedures at TMC please visit our website.

Dr. Layla Lucas

Dr. Layla Lucas of Saguaro Surgical is board-certified in General Surgery and Vascular/ Endovascular Surgery. Dr. Lucas has a special interest in wound healing, limb salvage, stroke prevention and treatment of aneurysmal disease. She has been trained in a wide variety of minimally invasive endovascular techniques, as well as traditional open procedures in order to treat the full spectrum of vascular diseases.

A miraculous recovery prompts Tucson stroke patient to give TMC staff a heartfelt thank you

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Tucson Medical Center clinical staff will tell you that simply helping people when perhaps they need it most is all the reward they need in their noble profession.  So when a patient comes back to say ‘thank you’ following an extraordinary recovery, it is instantly uplifting for them.

Sandy Goodsite recently came back to say ‘thank you,’ and hug the people who she credits with not only saving her life, but also giving her the quality of life she essentially had before April 22, 2014.

That’s when Goodsite, 72, suffered a significant stroke. She was rushed to TMC and received a clot-busting drug called tPA just 22 minutes after hitting the doors of the Emergency Department (ED), one of the fastest response times in the city.  You can read about her incredible ordeal here.

Goodsite is now about 95 percent recovered, as she continues speech and occupational therapies.  She and her husband, semi-retired pediatrician Dr. Ron Goodsite, felt compelled to come back and personally thank those who were working the day she was brought in via ambulance.  They were armed with thank you notes, addressed to every staff member who helped care for her.  As the Goodsites were ready to make their way to their first stop, they were greeted in the lobby by two members of the Neuro Red team, which responds to stroke victims.  “Talking to her, and seeing how well she’s doing reminds me why we do what we do,” said Shannon Bachman, RN.

The Goodsites headed inside TMC’s ED where staff was just as touched that Sandy is not only doing so well, but also took the time to come back.  “It is so fantastic that she came back because it’s typically very rare that we get to see a patient after they leave the ED,” said Heather Williams, ED clinical nurse lead.  Melissa Ritchey, director of TMC’s ED, echoed that sentiment.  “It reminds us why we come to work each day.  I’m so grateful that she came back to say thanks.  You only need to hear that one time to remember each and every time why we do what we do.”

Next stop: TMC’s Intensive Care Unit where Goodsite was greeted and immediately recognized by staff who hadn’t seen her since her two-day stay there in April.  “It’s so nice to see you up walking and talking!” said Jenny Tuttle, ICU clinical nurse lead.  “We always appreciate when people take the time to come back because we see them in a bed, in an acute setting.  It’s not very often we get to see the progress they’ve made, so it means a lot to us to see her doing so well,” she said.

On the neurological unit, clinical nurse lead Nancy Box said she was in awe.  “It’s so neat to see somebody come back and look so good because we rarely get to see the end result.  When they leave here, they typically have some sort of deficit, so it’s amazing to see Sandy talking and moving so well, and how her hard work during rehabilitation has paid off.”

The Goodsites are also catering a savory dinner for the three departments involved in Sandy’s care.  “We wanted to provide a little something for them – to do more than just say thank you,” she said.  But they realize that her incredible care started with the lightning fast response by Tucson Fire paramedics Bill Nielson and Robert Smith.  The Goodsites paid the boys in blue at station No. 7 a visit, and catered a dinner for the crew that was covered by the Arizona Daily Star and KGUN 9 On Your Side.

*Special thank you to TMC volunteer Mary Goeke who stayed late to accommodate the Goodsite’s visit.  Goeke helped transport the Goodsites from the different departments at TMC and said she felt honored to be a part of something so special.

TMC’s stroke response one of the fastest in the city; results in Tucson woman’s phenomenal recovery

“It was like serendipity.”

That’s how Dr. Ron Goodsite described his wife’s stroke, and subsequent response that led to her extraordinary recovery. Serendipity that everything fell into place as it did. “Sandy exhibits what an ideal patient’s response should be,” he said.

It happened April 22, 2014.

Sandy Goodsite TMC Stroke Survivor

Sandy Goodsite
TMC Stroke Survivor

Sandy Goodsite, 72, stopped by her medical management company for just a few minutes to get some things done when an employee noticed that she was unable to move, and staring into space. She realized something wasn’t right, and alerted Sandy’s daughter, who was in the next room. Sandy’s right side was beginning to droop. Her daughter immediately called 911. Within minutes, the office was full of firemen, and stunned employees watched as Sandy was loaded into an ambulance.

Longtime Tucson pediatrician Dr. Goodsite is now semi-retired, and works in the imaging department at TMC for Children. He was just finishing up his shift when his phone rang. It was his daughter telling him Mom was on her way in via ambulance. “It was really scary,” he said. “It can happen to any of us at anytime, and it can happen when you least expect it. When you have something like this that affects a loved one, it’s frightening.”

Sandy’s risk factors were well controlled. She had no symptoms. And absolutely no warning signs.

Her miraculous recovery started with the medic’s quick response time and communication to TMC that a suspected stroke patient was coming in. TMC is a designated Primary Stroke Center, and was recently honored with the Gold Plus award status for the fourth year in a row. TMC is also recognized as a recipient of the American Heart Association/American Stroke Association Target: Stroke Honor Roll.

Emergency Department staff triggered a hospital-wide alert called Neuro Red in which a team of people immediately report to the emergency room, including the rapid response nurse, house supervisor, lab technicians, and the neurologist on-call. In Sandy’s case, neurology resident Dr. Muhammad Kahn responded. Radiology was put on alert, and pharmacy was put on stand-by.

Sandy's stroke affected a significant  portion of her brain.

Sandy’s stroke affected a significant
portion of her brain.

As soon as Sandy hit TMC’s emergency department, her blood was drawn and a brain scan was performed. She had suffered an ischemic stroke, in which a blood clot broke off and traveled to the left side of her brain – the portion that controls speech and language. The stroke was significant. CT scans show the clot affected a baseball-sized portion of her brain. The right side of her body was completely weak, as is typical with stroke victims.

TMC Neurologist and Stroke Director Dr. David Teeple administered a drug called tissue plasminogen activator, or tPA. It’s approved by the FDA for treatment of ischemic stroke up to three hours after stroke, and works by dissolving the blood clot.

Ischemic stroke patients should get tPA within 60 minutes of hitting the emergency room. Sandy received it 22 minutes after she arrived at TMC, one of the fastest times in the city.

Dr. David Teeple TMC Neurologist & Stroke Director

Dr. David Teeple
TMC Neurologist & Stroke Director

“With stroke, time really is of the essence,” said Dr. Teeple. “Every minute, a stroke patient loses about 2 million brain cells. Every hour, they lose 120 million brain cells. The sooner you give tPA after the onset of stroke symptoms, the more effective it’s going to be. That first hour is really the golden hour where we can eliminate a lot of the brain damage caused by stroke if we administer tPA quickly. For Mrs. Goodsite to receive tPA 22 minutes after hitting the emergency room door is absolutely incredible.”

Six hours after tPA was administered, Sandy’s motor deficiency had disappeared. Sandy was in TMC’s intensive care unit for two days, followed by two more days in the neurological unit. Initially, she was unable to write. Her words all ran together. She mixed up right, left, up and down – a very common symptom of stroke. Sandy spent the next ten days at HealthSouth where she made big strides with her rehabilitation.

Each day, she started doing a little bit more. It didn’t take long for her ability to write and speak to come back. “My husband used to laugh because of my ability to multitask,” she said. “I’d work on three things at once, and it would drive him batty.” She’s working on being able to multitask once again, and also how to focus. She gets easily distracted, but did not lose any intellect during the stroke.

Dr. Ron & Sandy Goodsite

Dr. Ron & Sandy Goodsite

Dr. Goodsite finds himself wondering what would have happened if anything went differently that day. What if Sandy would have suffered that stroke while driving? What if those firemen were on another call, and it took them longer to respond? What if TMC wasn’t a designated Primary Stroke Center, and didn’t have the Neuro Red team in place? “We have a strong faith in God, and we believe we had help from above. We felt that someone was looking out for us, and especially looking out for Sandy,” said Dr. Goodsite.

Dr. Teeple said Sandy’s remarkable recovery is extremely gratifying from a physician standpoint. “This is the culmination of everything TMC, the city, and EMS have been working so hard on for the past five years. Since TMC is a Primary Stroke Center, we have the foundation in place to be fully prepared for these patients before they even get here. Everyone in every department that was involved – did the right thing, and worked together to get this result.”

“My appreciation of TMC has really gone up 1,000 percent since I’m now a person who has experienced this firsthand,” Dr. Goodsite concurred. “That day, I was at TMC – not as a physician, but as a husband. I am completely amazed at how the brain is able to recover once tPA is administered. But beyond that medication – the Neuro Red team TMC has in place – is incredible. As soon as Sandy hit the doors at TMC, she was immediately taken to the exam room and then her brain was scanned, and the tPA was administered. The response was remarkable.”

Doctors are still trying to find out exactly where the clot came from in Sandy’s body. She’s about 95 percent recovered, and making incredible strides with the occupational and speech therapy she is receiving twice a week. She has what’s known as expressive aphasia – similar to when you have a thought or a word “on the tip of your tongue.” It’s in your head, but you’re just having a hard time retrieving it. Day by day, however, she’s making big improvements.

The Goodsites have plans to formally thank the medics and TMC staff members who did everything right that day, which aided in her quick recovery. Dr. Goodsite said, “I can’t wait for Sandy to walk in, and see these people, and say ‘Thank you.’”

Tucson Medical Center | 5301 E. Grant Road | Tucson, Arizona 85712 | (520) 327-5461